Provider Demographics
NPI:1346578366
Name:EBY-MCKENZIE, CHARLES TIMOTHY (LMFT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:TIMOTHY
Last Name:EBY-MCKENZIE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD STE 331
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5225
Mailing Address - Country:US
Mailing Address - Phone:818-281-6109
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 331
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5225
Practice Address - Country:US
Practice Address - Phone:818-281-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist